Chapter 19 : Functional Magnetic Resonance Imaging in HIV-Associated Dementia

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Functional Magnetic Resonance Imaging in HIV-Associated Dementia, Page 1 of 2

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Neuroimaging studies can aid in the diagnosis of HIV-related brain diseases, as well as improve our understanding of the pathophysiology of HIV dementia. The ultimate goal of "functional" neuroimaging studies is to improve the understanding of common cognitive deficits in HIV patients, such as decreased sustained attention, mental flexibility, general motor speed, and short-term and working memory. To date, only three studies have used perfusion magnetic resonance imagery (pMRI) to evaluate cerebral perfusion in patients with HIV dementia. This chapter reviews some of the technical aspects of pMRI and blood oxygenation level-dependent (BOLD) functional MRI (fMRI), as well as the results of published studies of patients with HIV. Few fMRI or pMRI studies in patients with HIV brain injury have been published. The major findings from pMRI include frontal hypoperfusion, as well as subcortical gray-matter and parietal white-matter hyperperfusion. These regional perfusion abnormalities may reflect neuronal dysfunction or inflammatory changes. Finally, due to the highly reproducible intrasubject patterns of brain activation, fMRI holds great promise, not only for evaluating the extent of brain injury, but also for longitudinal clinical trials to monitor treatment effects in HIV-associated brain injury.

Citation: Ernst T, Tomasi D, Chang L. 2009. Functional Magnetic Resonance Imaging in HIV-Associated Dementia, p 273-280. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch19
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Image of FIGURE 1

Chain of events that link neuronal activation with BOLD signal changes on fMRI. Neuronal stimulation increases neuronal firing, which in turn leads to increased metabolism (glycolysis and oxygen consumption). These cellular events cause hemodynamic changes (increased transport of oxygenated blood to the activated regions), which alter the magnetic properties of the brain regions involved. The altered magnetic properties of the activated brain can be detected with susceptibility-weighted MR pulse sequences and analyzed to generate brain activation maps.

Citation: Ernst T, Tomasi D, Chang L. 2009. Functional Magnetic Resonance Imaging in HIV-Associated Dementia, p 273-280. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch19
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Image of FIGURE 2

Activated brain volume on fMRI in HIV patients and control subjects who performed several cognitive tasks. The control subjects showed increasing activated brain volume with task difficulty for simpler tasks (e.g., from zero-back [0B] and one-back [1B]) but saturation of activated volume with more complex tasks (two-back [2B] and one- and two-increment [1+ and 2+]). The HIV patients showed marked increases in activated brain volume for the simpler tasks (0B and 1B) but a saturation volume on the more difficult tasks similar to that of the control subjects. As a result, the “dynamic range” () in activated brain volume (the ratio of largest to smallest activated volume) was markedly reduced in HIV patients ( = 5) compared to control subjects ( = 20). This reduced dynamic range in HIV may be interpreted as reduced “brain reserve” as a result of injury to the neural substrate due the HIV infection.

Citation: Ernst T, Tomasi D, Chang L. 2009. Functional Magnetic Resonance Imaging in HIV-Associated Dementia, p 273-280. In Goodkin K, Shapshak P, Verma A (ed), The Spectrum of Neuro-AIDS Disorders. ASM Press, Washington, DC. doi: 10.1128/9781555815691.ch19
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